Thoracic Surgery Cleveland Clinic thoracic surgeons specialize in the diagnosis and surgical treatment of diseases of the lung and esophagus, including lung and esophageal cancer, lung failure, swallowing disorders and airway disease. Our staff offers a broad range of services, from the latest screening techniques to the most advanced minimally invasive surgical procedures.
General Thoracic Surgery Volume and Mortality Surgical Volume 2,000
Mortality (%) 6.0
1,500
4.5
1,000
3.0
500
1.5
0
2007
2008
2009
2010
2011
0
In 2011, Cleveland Clinic thoracic surgeons performed 1,380 procedures. The mortality rate was 2 percent.
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Outcomes 2011
Major Thoracic Surgery by Type (N = 1,380) 2011
Pulmonary procedures accounted for the majority of major thoracic surgical procedures at Cleveland Clinic in 2011. Our surgeons treat patients with a variety of conditions of varying complexity.
39% Pulmonary (N = 536)
18% Esophagus (N = 248)
100%
15% Pleura (N = 207) 10% Mediastinum/Diaphragm (N = 138) 10% Other (N = 143) 8% Lung Transplant (N = 108)
Pulmonary Resection Volume and Mortality
400
Volume
Mortality (%) 4
300
3
200
2
100
1
0
2007
2008
2009
2010
2011
0
Cleveland Clinic performed 282 pulmonary resections in 2011 and maintained a low rate of mortality.
Sydell and Arnold Miller Family Heart & Vascular Institute
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Thoracic Surgery (continued) Distribution of Pulmonary Resections by Type (N = 282) 2011 31% Video-Assisted Wedge (N = 86)
29% Open Lobectomy (N = 83)
100%
19% Video-Assisted Lobectomy (N = 53) 8% 6% 5% 2%
Pneumonectomy (N = 23) Open Wedge (N = 18) Other (N = 14) Segmentectomy (N = 5)
In 2011, the most common procedure was video-assisted wedge. Our surgeons perform a variety of less invasive, video-assisted procedures, which account for half of our pulmonary resections. They are also performing an increasing number of anatomic lung resections using minimally invasive techniques.
Pulmonary Resection Postoperative Length of Stay (N = 282) 2011 Days 5
Open VATS
4 3 2 1 0
Wedge Resection
Segmentectomy
Lobectomy
Pneumonectomy
Abbreviation: VATS, video-assisted thoracoscopic surgery
Cleveland Clinic’s multidisciplinary care model results in shorter length of stay for patients.
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Outcomes 2011
Stage-Specific Anatomic Resection: Stage I VATS vs. Open 2009 – 2011 Volume 100 VATS Open
80 60 40 20 0
2009
2010
2011
Major Pulmonary Resections Operative Mortality 2007 – 2011 Percent 2.0 1.5 1.0 0.5 0
2007
2008
2009
2010
2011
*University HealthSystem Consortium (UHC) Comparative Database, 2011 discharges.
UHC Expected
Postoperative Length of Stay > 14 days for Lobectomy, July 2008 – June 2011 Eligible Procedures Unadjusted Rate
238
3.4%
Risk-Adjusted Rate (95% CI)
Standardized Incidence Ratio (95% CI)
4.0% (12.4%, 6.1%)
0.874 (0.44, 1.12)
Cleveland Clinic
Min 0.59
25th Median 75th 0.91 1.01 1.14
Max 2.00
= STS standardized incidence ratio Source: STS General Thoracic Surgery Database, July 2008 – June 2011.
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Thoracic Surgery (continued) Lobectomy Length of Stay 2011 2011 Median (Days) 6
When possible, lobectomy is performed using a minimally invasive technique and video assistance to allow patients to leave the hospital sooner and return to work earlier.
4 2 0
Open Lobectomy (N = 83)
Video-Assisted Lobectomy (N = 53)
Esophageal Surgery Volume 2007 – 2011 Volume 400
Major esophageal surgery includes resections for cancer and reoperative surgery for motility and reflux disorders. In 2011, we performed 247 esophageal operations with a low mortality of 2 percent.
300 200 100 0
2007
2008
2009
2010
Esophagectomy Mortality Three Years After Surgery 2011
2011 Percent 4 3 2 1
Source: STS General Thoracic Surgery Database, July 2008 – June 2011.
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0
3 yr Observed
3 yr STS Expected Outcomes 2011
Combined Morbidity/Mortality for Esophagectomy, July 2008 – June 2011 Eligible Procedures Unadjusted Rate
137
25.5%
Risk-Adjusted Rate (95% CI)
Standardized Incidence Ratio (95% CI)
23.6% (17.5%, 30.5%)
0.88 (0.65, 1.13)
Cleveland Clinic
Min 0.47
25th Median 75th 0.92 1.00 1.23
= STS standardized incidence ratio
Max 2.00
Source: STS General Thoracic Surgery Database - July 2008 – June 2011.
Distribution of Esophageal Surgeries by Indication (N = 247) 2011
32% Cancer (N = 80)
100%
31% Reflux (N = 76)
28% Other (N = 69) 9% Achalasia (N = 22)
Our surgeons manage high volumes of both benign and malignant esophageal conditions.
Sydell and Arnold Miller Family Heart & Vascular Institute
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